INTRODUCTION: Pulmonary embolism (PE) is a life-threatening emergency requiring rapid diagnosis. This study evaluates the diagnostic performance and distribution of the Wells score and Pulmonary Embolism Rule-Out Criteria (PERC) among emergency department (ED) patients who underwent computed tomography pulmonary angiography (CTPA) for suspected pulmonary embolism (PE), and examines how often confirmed PE occurred in patients classified as low risk by these tools.
METHODS: We conducted a retrospective observational study in the emergency department of a tertiary hospital. Adult patients (≥18 years) who underwent computed tomography pulmonary angiography (CTPA) for suspected PE between January and December 2023 and in whom Wells and PERC scores could be retrospectively calculated were included. Diagnostic accuracy was analyzed using receiver operating characteristic (ROC) curves. Since the cohort includes only imaged patients, results apply specifically to CTPA-selected populations.
RESULTS: We included 299 patients, with a mean age of 67.4±16.1 years; 96 (32.1%) had confirmed PE. Among PE-positive cases, 7 (7.3%) had a PERC score of 0, and 42 (43.8%) had Wells <2; 7.3% were low risk by the rules. Wells (2.91±2.21 vs. 1.09±1.48) and PERC (1.60±1.17 vs. 0.82±0.85) scores were significantly higher in PE-positive than PE-negative patients (p<0.001). ROC analysis showed AUC 0.771 for Wells and 0.711 for PERC. Negative predictive values were 89.3% (Wells) and 91.2% (PERC). Higher scores correlated with worse outcomes, including ICU admission and mortality (p<0.001).
DISCUSSION AND CONCLUSION: Important PEs occurred even in patients classified as low risk, indicating these scores should support but not replace clinical judgment.

INTRODUCTION: Neurocutaneous diseases are genetically heterogeneous syndromes that affect the central and peripheral nervous systems, the skin, and other organs. The most common include Neurofibromatosis (NF) types 1 and 2, tuberous sclerosis complex (TSC), and Sturge-Weber Syndrome (SWS). This study aimed to compare serum cofactor (calcium [Ca], phosphorus [P], magnesium [Mg], etc.) and coenzyme (vitamin B12 [Vit B12], folate, vitamin D [Vit D]) levels in children with phacomatoses aged 18 years or less and healthy controls.
METHODS: Fifty patients with neurocutaneous disorders (26 girls, 24 boys) and 50 age-, gender-, and socioeconomically matched healthy con-trols were evaluated. Serum cofactor and coenzyme levels were measured and statistically compared between groups.
RESULTS: Ferritin (27.8±16.8 vs. 41±26.4 ng/mL) and Vit D levels (18.1±9.2 vs. 23.5±11.3 ng/mL) were significantly lower in patients compared with controls (p<0.05). No significant group differences were found in Ca, P, Mg, alkaline phosphatase [ALP], or thyroid function tests. Vit B12 concentrations were similar between the two groups (p>0.05). Within the disease subgroups, significant variations were observed in hemoglobin [Hb], hematocrit [Hct], folate, ferritin, and Vit D levels, with the most pronounced deficiencies occurring in the NF1 and TSC groups.
DISCUSSION AND CONCLUSION: In children with phacomatoses—particularly those with NF1 and TSC—levels of ferritin, folate, and Vit D are noticeably lower than in healthy peers. Other cofactors and coenzymes tend to be comparable between groups. Therefore, routine monitoring of these three markers is recommended for pediatric patients with neurocutaneous disorders.

INTRODUCTION: COVID-19 pneumonia is associated not only with respiratory failure but also with an increased risk of cardiac involvement and mortality. The frontal QRS/T angle, automatically obtained from a standard ECG, reflects the electrical difference between ventricular depolarization and repolarization. This study aimed to investigate the prognostic value of the frontal QRS/T angle in patients presenting to the emergency department with COVID-19 pneumonia.
METHODS: In this retrospective study, 288 adult patients who presented to the emergency department with a diagnosis of COVID-19 pneumonia were included. Demographic, clinical, and laboratory data, along with frontal QRS/T angles obtained from initial ECGs, were analyzed. Clinical outcomes (discharge, ICU admission, mortality) were compared with laboratory and ECG parameters.
RESULTS: ROC analysis identified >47.5° as the optimal threshold for fQRS/T (AUC=0.628; sensitivity 55.9%; specificity 72.6%). In-hospital mortality was approximately three times higher in patients with fQRS/T >47.5° compared to those with ≤47.5°. The fQRS/T angle showed positive correlations with troponin, CK-MB, BUN, creatinine, and CRP. Logistic regression analysis revealed that pulse rate and length of hospital stay were independently associated with mortality.
DISCUSSION AND CONCLUSION: A widened fQRS/T angle is associated with increased mortality in COVID-19 pneumonia and may serve as a noninvasive marker of systemic inflammation. Due to its simplicity, cost-effectiveness, and rapid applicability, it may be a valuable parameter for early risk stratification in emergency departments. Prospective multicenter studies are needed to validate these findings.

INTRODUCTION: This prospective single-centre study aimed to investigate the association between the C-reactive protein–albumin–lymphocyte (CALLY) index and hospital length of stay (LOS) in patients with acute pancreatitis (AP), and to assess its concordance with conventional severity scores.
METHODS: A consecutive cohort of 119 AP patients was enrolled. Admission CALLY indices were calculated, and Ranson scores, CT severity index (CTSI) values, and ICU requirement were recorded. Receiver operating characteristic/ area under the curve (AUC) analysis, logistic regression, and negative binomial regression models were applied.
RESULTS: The CALLY index demonstrated moderate discrimination for LOS ≥ 7 days (AUC = 0.64, 95% CI 0.48–0.81), with the optimal cut-off at 0.0082. In logistic regression, lower log(CALLY) was associated with prolonged stay (OR ≈ 0.73, p ≈ 0.04). In negative binomial regression, each 1-log unit decrease in CALLY corresponded to an ~8% increase in LOS (IRR ≈ 0.92, p ≈ 0.03). Conventional severity measures (Ranson, CTSI) and ICU requirement were not significantly associated with LOS.
DISCUSSION AND CONCLUSION: The CALLY index was independently associated with prolonged hospital stay in AP but not with traditional severity measures, suggesting it may reflect the systemic inflammatory recovery phase. Large multicentre validation studies are warranted.

INTRODUCTION: This study aimed to evaluate survival outcomes and prognostic factors in cervical cancer patients treated with radical chemoradiotherapy (CRT).

METHODS: Between 2020 and 2024, 73 patients with cervical cancer underwent definitive EBRT (External Beam Radiotherapy) plus IGABT (Image-Guided Adaptive Brachytherapy); 67 received concurrent chemotherapy (CT), and 6 received RT alone. Statistical analyses were conducted using Jamovi and JASP software. Kaplan-Meier and log-rank tests were used for survival analysis, while Cox regression was employed to identify prognostic factors. A p-value ≤0.05 was considered significant.
RESULTS: The median age was 55 years. Based on FIGO 2018 staging, 31.5% (n=23) were stage I–II and 68.5% (n=50) were stage III–IV. The median RT dose was 45 Gy. The mean HRCTV D90 was 88±9.4 Gy. The median overall treatment time (OTT) was 62 days. One- and three-year overall survival (OS) and disease-free survival (DFS) rates were 85% and 70%, and 80% and 65%, respectively. In univariate analysis, tumor size >4 cm prior to brachytherapy and OTT >50 days were significantly associated with poorer DFS and LRDFS. Additionally, non-cisplatin chemotherapy regimens were significantly associated with worse LRDFS (p<0.05). In multivariate analysis, both pre-brachytherapy tumor size >4 cm and non-cisplatin regimens remained independent negative prognostic factors for LRDFS (p<0.05).
DISCUSSION AND CONCLUSION: Radical CRT combined with brachytherapy remains an effective treatment modality for cervical cancer. However, prolonged OTT and persistent large tumor size before brachytherapy are associated with worse survival outcomes. Furthermore, survival rates may vary based on disease stage distribution, with lower survival expected in cohorts dominated by advanced-stage cases.

INTRODUCTION: This study aimed to evaluate the demographic, clinical, and radiological characteristics, treatment approaches, and outcomes of patients diagnosed with subarachnoid hemorrhage (SAH) at a tertiary neurosurgery center, distinguishing between traumatic and spontaneous (aneurysmal and non-aneurys-mal) etiologies.
METHODS: A total of 188 patients diagnosed with SAH between September 2023 and September 2025 were retrospectively reviewed. Patients were classified as having traumatic or spontaneous SAH based on etiology. Demographic characteristics, imaging findings, aneurysm features, complications (vasospasm, hydrocephalus), treatment modalities, and clinical outcomes were recorded and analyzed.
RESULTS: Of the 188 patients, 126 (67.0%) had traumatic SAH and 62 (33.0%) had spontaneous SAH. The mean age was 40.6±23.6 years in traumatic cases and 52.0±14.1 years in spontaneous cases. Aneurysmal rupture accounted for 74.2% of spontaneous SAH cases, most frequently involving the anterior commu-nicating artery (27.4%) and the middle cerebral artery (21.0%). Vasospasm occurred in 19.3% and hydrocephalus in 14.5% of spontaneous cases. The overall mortality rate was 1.6%, and favorable neurological recovery (mRS ≤ 3) was achieved in 83.9% of patients
DISCUSSION AND CONCLUSION: Traumatic SAH occurs predominantly in younger males, whereas spontaneous SAH most commonly results from aneurysm rupture. Early di-agnosis, multidisciplinary management, vasospasm monitoring, and the widespread use of endovascular therapy are key factors in reducing mortality and improving neurological recovery.

INTRODUCTION: Early intervention is crucial for out-of-hospital cardiac arrest cases. As healthcare facilities that are in regular contact with the public, pharmacies are potential environments where emergencies may occur. The aim of this study is to evaluate the impact of Basic Life Support (BLS) training on the knowledge and skills of pharmacists and pharmacy assistants in the province of Ankara.
METHODS: This pre-post descriptive study was conducted from May to August 2025 with ethics approval. A total of 258 pharmacists received 16-hour BLS training based on the 2020 AHA guidelines. A 20-question test and a practical skills exam were administered before and after training. Data were analyzed using the Wilcoxon signed-rank test, Kruskal–Wallis test, and Spearman correlation.
RESULTS: 93% of participants were pharmacists, and 7% were other personnel. The 79.7±8.4 average score of the pre-test rose to 95.7±4.1 for the post-test, and this rise was found to be statistically significant (p<0.001). The mean score for the practical exam was 97.7±1.8. 99.6% of all participants were successful. It was determined that there was a negative correlation between the number of working years and both pre-test (r=-0.184, p<0.05) and post-test (r=-0.286, p<0.05) scores. The lowest scores were observed in the group with 20 years or more of experience.
DISCUSSION AND CONCLUSION: BLS training significantly improved the knowledge level of pharmacists and pharmacy assistants. The decline in test performance as professional experience increases highlights the necessity of regular refresher training, particularly for senior professionals.

INTRODUCTION: This study aimed to evaluate the frequency, causes, and risk factors of emergency department visits among children diagnosed with rheumatologic diseases.
METHODS: Patients aged 0–18 years with a diagnosis of a rheumatologic disease who presented to the Pediatric Emergency Department for any reason between June 2024 and June 2025 were retrospectively reviewed. Demographic characteristics, diagnoses, treatments, and reasons for emergency department visits were recorded. Diagnoses were categorized into four groups: periodic fever syndromes, juvenile idiopathic arthritis and/or uveitis, vasculitis, and connective tissue diseases.
RESULTS: A total of 366 patients were included; 50.8% were female and 49.2% were male. The most common diagnoses were familial Mediterranean fever (41.2%) and juvenile idiopathic arthritis (21.5%). The median number of emergency department visits during the previous year was 1 (range, 1–10). Patients with periodic fever syndromes had a significantly higher frequency of emergency department visits compared with other groups (p=0.003). Younger age at diagnosis was also associated with more frequent emergency department visits (p = 0.044). The leading reasons for visits were infections (45.8%) and disease flares (42.3%). Patients receiving nonsteroidal anti-inflammatory drugs had a lower frequency of visits (p=0.03). In multivariate analysis, periodic fever syn-drome was identified as an independent risk factor for multiple emergency department visits (OR: 1.914; 95% CI: 1.118–3.275).
DISCUSSION AND CONCLUSION: In pediatric patients with rheumatologic diseases, infections represent the most common cause of emergency department visits.Younger age at diagnosis and periodic fever syndromes are important factors associated with increased visit frequency.These findings suggest that distinguishing disease flares from infections and providing family education may help optimize the management of emergency department visits.

INTRODUCTION: Coronary artery bypass grafting (CABG) and valve surgeries are vital for treating severe cardiac disease. Patients with reduced ejection fraction (EF) (<50%) have higher perioperative risks than those with preserved EF (≥50%). This study compares outcomes by EF and age (<65 vs. ≥65 years) to support individualized management.
METHODS: This retrospective study included patients treated between 2018 and 2023. Patients were categorized by ejection fraction (EF) (pre-served [≥50%] or reduced [<50%]) and age (<65 or ≥65 years). The collected data included demographics, preoperative characteristics, intraoperative details, and postoperative outcomes (including transfusions, vasopressor use, arrhythmia, mortality, and intensive care unit stay duration).
RESULTS: Among 610 patients (354 with preserved EF and 256 with reduced EF), the reduced EF group required more perioperative noradrenaline (16.8% vs. 10.2%, p=0.01) and intensive care unit (ICU) adrenaline (14.5% vs. 8.8%, p=0.02). Perioperative arrhythmia was more frequent in reduced EF patients (67.2% vs. 57.1%, p=0.01). ICU stays were longer in the reduced EF group (4.75±7.44 vs. 3.28±4.98 days, p=0.02). Significant differences were observed in transfusion rates (intensive care unit (ICU): p <0.001) and pacing requirements (p=0.007). Mortality did not differ between groups. Subgroup comparisons showed significant differences in survival across age and EF categories (p=0.023)
DISCUSSION AND CONCLUSION: Reduced EF is associated with greater hemodynamic instability, higher arrhythmia incidence, and prolonged ICU stay. Age further influenced these outcomes, highlighting the need for individualized perioperative management strategies in high-risk cardiac surgery patients.

INTRODUCTION: Distal tibial metaphyseal fractures present significant clinical challenges due to complex fracture patterns, limited soft-tissue coverage, and compromised vascularity. This study aimed to investigate the effect of medial plate positioning on postoperative complications and to identify predictors of non-union and soft-tissue complications following medial plating.
METHODS: A retrospective study was conducted on 78 adult patients who underwent medial distal tibial plate fixation for distal tibial metaphyseal fractures between 2016 and 2024. Demographic, fracture-related, and surgical parameters were analyzed. Radiographic assessments included measurement of plate level relative to the ankle joint and medial malleolus using standardized ratio-based methods. Outcomes included union, deformity, and soft-tissue complications.
RESULTS: Soft-tissue complications occurred in 23.1% of patients and were significantly associated with open fractures (p=0.012), staged treatment (p=0.008), and lower union rates (p=0.026). Plate level ratios (b/a, c/a) showed no association with soft-tissue complications. Nonunion occurred in 14.1% of patients and was significantly associated with left-sided fractures (p=0.018), AO type A patterns (p=0.003), and the presence of varus deformity at final follow-up (p=0.002). Plate position and plate level ratios were not predictive of nonunion (p>0.05).
DISCUSSION AND CONCLUSION: In distal tibial metaphyseal fractures, the level of medial plate placement was not associated with soft-tissue complications or nonunion. In contrast, open injury, treatment stage, fracture type, and residual varus deformity were identified as the primary determinants of adverse outcomes. These factors should therefore be considered during surgical planning and postoperative follow-up.

INTRODUCTION: Extra-articular distal radius fractures are common injuries for which percutaneous kirschner wire fixation (PKW) and volar locking plate (VLP) fixation remain widely used surgical approaches. Despite their frequent application, the comparative effectiveness of these techniques—particularly regarding early postoperative recovery and long-term functional outcomes—continues to be debated. This study aimed to compare the clinical, functional, and radiological results of PKW versus VLP in adult patients with extra-articular distal radius fractures.
METHODS: This retrospective cohort study included adult patients treated surgically for extra-articular distal radius fractures (AO/OTA 2R3A2–2R3A3) between 2017 and 2024. Patients were assigned to PKW or VLP based on the surgical approach. Demographic characteristics, postoperative pain, functional outcomes (DASH, PRWE), and radiographic parameters were evaluated. Postoperative measures were analyzed. Statistical significance was set at p<0.05.
RESULTS: Sixty-two patients met the inclusion criteria (PKW: n=24; VLP: n=38). Early postoperative pain was significantly lower in the PKW group on day 1 (p<0.001), and hospital stay was shorter compared with VLP (p<0.001). By 6 weeks and at final follow-up, VAS scores were comparable. DASH and PRWE scores showed no significant differences between the techniques. Radiographic restoration of alignment was similar between groups, and complication rates were low in both cohorts.
DISCUSSION AND CONCLUSION: PKW and VLP provide equivalent long-term functional and radiological outcomes in extra-articular distal radius fractures. PKW offers distinct advantages in early recovery, including reduced postoperative pain and shorter hospitalization, supporting its use as a minimally invasive and effective alternative in appropriately selected patients.

INTRODUCTION: The aim of this study is to adapt the Career Indecisiveness Scale developed by Callanan (1989) into Turkish and to examine the scale's validity and reliability. In this context, it also aims to gain a deeper understanding of the difficulties working adults encounter in their career decision-making processes.
METHODS: Following the acquisition of all required institutional permissions, data were obtained via a structured questionnaire from 590 physicians and nurses employed under the Izmir Katip Çelebi University To evaluate the construct validity of the instrument, an exploratory factor analysis (EFA) was initially performed, which was subsequently supported by a confirmatory factor analysis (CFA).
RESULTS: The analyses identified a six-factor structure consisting of 29 items. When the goodness-of-fit indices were evaluated collectively, the resulting model was found to represent the best-fitting structure. Reliability analysis yielded a Cronbach’s alpha coefficient of 0.854, indicating that the reliability levels were within acceptable limits and that the scale demonstrated satisfactory internal consistency. The findings further showed that the scale possessed convergent validity at levels consistent with internationally accepted methodological standards. In addition, the second-order confirmatory factor analysis (CFA) confirmed that the six-factor structure adequately represented the overarching construct of career indecision.
DISCUSSION AND CONCLUSION: The findings indicated that the lack of information about the work environment factor exerted a stronger influence on career indecision than the other dimensions. Overall, the results derived from the analyses confirmed that the adapted Career Indecision Sources Scale demonstrates robust validity and reliability, thereby supporting its suitability for use in future empirical research.

INTRODUCTION: Sarcoidosis-associated uveitis is rare in children and can cause serious complications. Because pediatric data were limited, this study aimed to characterize clinical features, management, and outcomes using a multidisciplinary cohort approach.
METHODS: A retrospective analysis was conducted of patients under 18 years of age who were managed by the pediatric rheumatology and ophthalmology services between 2017 and 2024. Patients were classified as having probable sarcoidosis-associated uveitis according to the revised International Workshop on Ocular Sarcoidosis (IWOS)criteria because no biopsy was performed. Demographics, clinical characteristics, laboratory findings, treatments, and outcomes were analyzed.
RESULTS: Of the 24 patients screened, 15 (27 eyes) met the inclusion criteria. Age at inclusion was 14.73±2.87 years; age at diagnosis, 10.15 years (IQR, 8.28–11.23). The majority of patients presented with concurrent ocular and systemic sarcoidosis (73%), bilateral involvement (80%), and panuveitis (60%). Chronic inflammation occurred in 80% of patients. Pulmonary involvement was documented in 40% of cases All patients received topical corticosteroids; 86.7% required systemic corticosteroids. Methotrexate was the first-line conventional DMARD (93.3%), and adalimumab was the primary biologic agent (80%). Complete remission was achieved in 53.3% of cases, with surgery needed in 20% of cases. Ocular complications decreased from 33.3% at presentation to 20% at final follow-up. Neither age at onset nor pulmonary involvement significantly influenced remission status.
DISCUSSION AND CONCLUSION: Pediatric sarcoidosis-associated uveitis emphasizes the importance of a collaborative team-based approach. The absence of pulmonary involvement does not exclude the diagnosis, underscoring the need for a high index of clinical suspicion and comprehensive evaluation in children presenting with chronic uveitis.

INTRODUCTION: To compare radiological evolution and clinical outcomes after burr-hole evacuation of chronic subdural hematoma (CSDH) using subdural versus subgaleal/subperiosteal drains.
METHODS: We retrospectively reviewed 127 consecutive adults who underwent burr-hole surgery for CSDH (2018–2025) at a single tertiary cen-ter. Patients were grouped by drain type: subdural (n=113) or subgaleal/subperiosteal (n=14). Subdural space thickness (sum of both sides in bilateral cases) was measured on CT preoperatively, on postoperative day 1, and at ~2 weeks. The primary outcome was residual subdural thickness at follow-up imaging. Subdural thicknesses were compared between the groups using ANCOVA, with drain type as the main factor and age, baseline thickness, preoperative midline shift, sex, and anticoagulant use as covariates. Clinical outcomes included recurrence requiring reoperation, postoperative Glasgow Coma Scale (GCS), ICU admission, and length of stay.
RESULTS: Groups were similar in age and sex, but the subgaleal/subperiosteal group more frequently used anticoagulants and had greater preoperative midline shift. On postoperative day 1, subgaleal/subperiosteal drainage was associated with greater subdural thickness than subdural drainage (18.1 vs 14.7 mm, p=0.005). At 2 weeks, residual thickness did not differ significantly (10.3 vs 13.2 mm; p=0.161). Recurrence requiring reoperation occurred in 3.1% (4/127), all in the subdural group. Postoperative GCS, ICU admission, and hospital length of stay were comparable.
DISCUSSION AND CONCLUSION: Subgaleal/subperiosteal drains were associated with greater early residual subdural hematoma but similar 2-week radiological resolution compared with subdural drains, with low recurrence and comparable clinical outcomes. Subgaleal/subperiosteal drainage appears to be a safe alternative in CSDH surgery.

Autism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental condition characterized by difficulties in social communication and is defined as a neurodevelopmental disorder. Gastrointestinal (GI) comorbidities, reported at markedly higher rates than in neurotypical populations, are increasingly recognized as clinically relevant modulators of core and associated ASD symptoms. These disturbances—often manifesting as constipation, diarrhea, abdominal pain, and gastroesophageal reflux—are frequently accompanied by pronounced feeding selectivity, sensory hypersensitivity, and nutrient deficiencies. Emerging evidence implicates gut microbiota dysbiosis in ASD pathophysiology, acting through immune, metabolic, and neurochemical pathways within the gut–brain axis. Alterations in microbial diversity and taxa abundance, including depletion of fiber-associated genera and enrichment of pro-inflammatory species, may contribute to both GI and behavioral phenotypes. Although dietary interventions such as gluten-free/casein-free, ketogenic, specific carbohydrate diets, and the Mediterranean diet have been proposed to restore microbial homeostasis, clinical evidence remains limited and inconsistent. Fecal microbiota transplantation (FMT) is an innovative treatment approach that preliminary open-label studies suggest may provide lasting improvements in GI and neurobehavioral areas. However, its long-term safety, efficacy, and mechanisms should be confirmed through rigorously designed randomized controlled trials. Future research should adopt multi-omics and longitudinal approaches to delineate causal relationships between microbiota alterations and neurodevelopmental outcomes, enabling the development of targeted microbiome-based and personalized nutritional strategies. Such precision interventions hold promise for addressing the unmet clinical needs of individuals with ASD.

Hydatid cyst disease is a zoonotic infection caused by Echinococcus granulosus. Isolated renal involvement is extremely rare, and cysts are usually diagnosed radiologically. However, they can sometimes mimic renal tumors. We present the case of a 53-year-old woman who was incidentally diagnosed with a renal mass during abdominal imaging. She underwent laparoscopic transperitoneal partial nephrectomy. Preoperative and intraoperative findings suggested a renal tumor; however, histopathological analysis confirmed the diagnosis of a hydatid cyst. Isolated renal hydatid cysts are rare and can mimic renal tumors. Laparoscopic transperitoneal partial nephrectomy is a safe and effective treatment method.